ACP Updates Antibiotics Recommendations for Common Infections

The American College of Physicians (ACP) has updated its recommendations for the use of short-duration antibiotics to treat several common bacterial infections.

The update follows a review of published clinical guidelines, systematic reviews, and relevant individual studies in attempt to address antimicrobial overuse and antibiotic resistance.

Among the common bacterial infections included in the update:

• Chronic obstructive pulmonary disease exacerbations and acute uncomplicated bronchitis should be limited to 5 days of antibiotic treatment.
• Community-acquired pneumonia should be treated with a minimum of 5 days of antibiotic treatment, and treatment should be extended based on the patient’s clinical stability.
• Uncomplicated bacterial cystitis in women should be treated with nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin in a single dose.
• Uncomplicated pyelonephritis should be treated with fluoroquinolones for 5 to 7 days or TMP-SMZ for 14 days based on antibiotic susceptibility.
• Nonpurulent cellulitis should be treated with a 5- to 6-day course of antibiotics for streptococci.

“When clinically safe and supported by evidence, shortening the duration of antibiotic therapy decreases overall antibiotic exposure, reducing the selection pressure for resistant organisms as well as a patient’s risk for adverse effects from antibiotics,” the ACP panel wrote.

—Leigh Precopio

Reference:

Lee RA, Centor RM, Humphrey LL, Jokela JA, Andrews R, Qaseem A. Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of Physicians. Ann Intern Med. Published online April 6, 2021. https://doi.org/10.7326/M20-7355